The oral cavity has seldom been described as a mirror because it reflects the health of a person. Alterations indicative of disease are seen as changes in the oral mucosa lining the mouth can reveal systemic conditions, such as minor irritations. These changes occur occasionally in all people and are usually viral-related, self-limiting, and easily treated.

Oral mucous membrane problems can be encountered in any setting, particularly in home care and hospice settings. Prevention of oral disease and careful treatment planning are necessary to reduce oral disease and the need for, and potential conflicting outcome of, operative intervention.

Increase the frequency of oral hygiene by rinsing with one of the suggested solutions between brushings and once during the night especially if signs of mild stomatitis (dryness and burning; mild erythema and edema along mucocutaneous junction) occur.

This will reduce further damage and may promote comfort.

Provide systemic or topical analgesics as prescribed.

This will provide comfort and relieve pain.

Discontinue flossing if it causes pain.

Increased sensitivity to pain is a result of thinning of oral mucosal lining.

Explain that topical analgesics can be administered as “swish and swallow” or “swish and spit” 15 to 20 minutes before meals, or painted on each lesion immediately before mealtime.

Each treatment must be performed as prescribed for optimal results.

Instruct patient to hold solution for several minutes before expectoration.

This measure enhances therapeutic effect.

Explain the use of topical protective agents.

A variety of more protective agents are available to coat the lesions and promote healing as prescribed.

Zilactin or Zilactin-B

This medicated gel contains benzocaine for pain and is painted on the lesion and allowed to dry to form a protective seal and promote healing of mouth sores.

Gelclair

This is a bioadherent oral gel that covers the oral cavity and forms a protective barrier to relieve pain.

The substance is prepared by allowing antacid to settle. The pasty residue is swabbed onto the inflamed areas and after 15 to 20 minutes, rinsed with saline or water. The residue remains as a protectant on the lesion.

Palifermin

This agent decreases the incidence and duration of severe oral mucositis in patients with hematological cancers undergoing high-dose chemotherapy followed by bone marrow transplantation.

For severe mucositis infection:

Give local antimicrobial agents as ordered.

Mycostatin, nystatin, and Mycelex Troche are commonly prescribed.

Stop the use of a toothbrush and flossing.

Brushing could increase damage to ulcerated tissues. A disposable foam stick (Toothette) or sterile cotton swab is a way to gently apply cleansing solutions.

If patient does not have a bleeding disorder and is capable to swallow, encourage to brush teeth with a soft pediatric-sized toothbrush using a fluoride-containing toothpaste after every meal and to floss teeth daily.

The toothbrush is the most important tool for oral care. Brushing the teeth is the most effective method for reducing plaque and controlling periodontal disease.

Use tap water or normal saline to provide oral care; do not use commercial mouthwashes containing alcohol or hydrogen peroxide. Also, do not use lemon-glycerin swabs.

Alcohol dries the oral mucous membranes Hydrogen peroxide can injure oral mucosa and is remarkably foul-tasting to patients. Lemon-glycerin swabs can result in decreased salivary amylase and oral moisture, as well as erosion of tooth enamel.

Dietary modifications may be needed to facilitate healing and tissue integrity.

Use foam sticks to moisten the oral mucous membranes, clean out debris, and swab out the mouth of the edentulous patient. Do not use to clean the teeth or else the platelet count is very low, and the patient is prone to bleeding gums.

Studies have revealed that foam sticks are apparently not effective for removing plaque from teeth.

Maintain inside of the mouth moist with frequent sips of water and salt water rinses.

Moisture promotes the cleansing effect of saliva and helps avert mucosal drying, which can result in erosions, fissures, or lesions.

Provide scrupulous oral care to critically ill patients.

Cultures of the teeth of critically ill patients have produced notable bacterial colonization, which can cause nosocomial pneumonia.

If whitish plaques are evident in the mouth or on the tongue and can be rubbed off readily with gauze, leaving a red base that bleeds, suspect a fungal infection and contact the physician for follow-up.

Oral candidiasis (moniliasis) is remarkably common secondary to antibiotic therapy, steroid therapy, HIV infection, diabetes, or immunosuppressive drugs and should be treated with oral or systemic antifungal agents.

Refer the patient to the dietitian for instructions on the maintenance of a well-balanced diet.

Nutritional expertise may be necessary to optimize the therapeutic diet needed to facilitate healing.

Instruct patient to avoid alcohol or hydrogen peroxide-based commercial products for mouth care and to avoid other irritants to the oral cavity (e.g., tobacco, spicy foods).

Oral irritants can further break and infect the oral mucosa and increase the patient’s discomfort.

For continuity of care, instruct the patient or caregiver to perform the following:

Lightly brush all surfaces of the teeth, gums, and tongue with a soft-bristled nylon or foam brush. Floss smoothly.

Gil Wayne graduated in 2008 with a bachelor of science in nursing and during the same year, earned his license to practice as a registered nurse. His drive for educating people stemmed from working as a community health nurse where he conducted first aid training and health seminars and workshops to teachers, community members, and local groups. Wanting to reach a bigger audience in teaching, he is now a writer and contributor for Nurseslabs since 2012 while working part-time as a nurse instructor. His goal is to expand his horizon in nursing-related topics, as he wants to guide the next generation of nurses to achieve their goals and empower the nursing profession.

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